Nguyen Hoang Hai, Trinh Ngan Thi Thanh, Tran Minh-Hoang, Pham Hong Tham
Department of Cardiac Intensive Care and Cardiomyopathy, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam.
Department of Cardiology, Trung Vuong Hospital, Ho Chi Minh City, Vietnam.
BMC Cardiovasc Disord. 2025 Apr 2;25(1):245. doi: 10.1186/s12872-025-04679-8.
Masked uncontrolled hypertension (MUCH) is associated with an increasing risk of morbidity and mortality. Current literature on MUCH lacks data on patients with end-stage kidney disease (ESKD) on hemodialysis (HD). We aimed to investigate the prevalence, ambulatory blood pressure (BP) characteristics, and risk factors of MUCH in this population in a low-middle-income Asian country.
We conducted a simple random-sampling, cross-sectional study on patients with hypertension and ESKD on HD. The outcome was MUCH, which was confirmed if the participants, who were on 24-hour ambulatory BP monitoring, had at least 1 of the following criteria: (1) daytime mean ambulatory BP ≥ 135 mmHg (systolic) and/or ≥ 85 mmHg (diastolic); (2) night-time mean ambulatory BP ≥ 120 mmHg (systolic) and/or ≥ 70 mmHg (diastolic); or (3) 24-hour mean ambulatory BP ≥ 130 mmHg (systolic) and/or ≥ 80 mmHg (diastolic). Data were presented using descriptive statistics. We used logistic regression to explore the risk factors for MUCH, and the results were reported with odds ratio (OR) and 95% confidence interval (95% CI).
Among 104 participants included for analysis (median age 54.5, 48.1% being female), MUCH was reported on 85 of them (prevalence of 81.7%, 95% CI 73.2-88.0%.). Non-dipping status of BP were found in 98.1% of the participants, with non-dippers dominating the normotension group (prevalence of 57.9%, 95% CI 36.3-76.9%) and reverse dippers dominating the MUCH group (prevalence of 65.9%, 95% CI 55.3-75.1%). We also identified some factors that were associated with a higher risk of MUCH, i.e., being current smoker (adjusted OR = 3.49, 95% CI 1.07 to 11.40), undergoing HD for > 48 months (adjusted OR = 5.69, 95% CI 1.48 to 21.81), taking > 3 antihypertensive medications (adjusted OR = 3.64, 95% CI 1.11 to 11.92), and requiring α2-adrenergic receptor agonists for BP control (adjusted OR = 6.31, 95% CI 1.12 to 35.62).
The prevalences of MUCH and non-dipping of BP (non-dipper and reverse dipper) were very high in patients with ESKD who were undergoing HD for a median duration of 6 years without ambulatory BP monitoring. To avoid extra cost and inconvenience, risk factors should be initially screened for MUCH before monitoring out-of-office BP for a confirmed diagnosis.
隐匿性未控制高血压（MUCH）与发病和死亡风险增加相关。目前关于MUCH的文献缺乏终末期肾病（ESKD）血液透析（HD）患者的数据。我们旨在调查一个中低收入亚洲国家该人群中MUCH的患病率、动态血压（BP）特征及危险因素。
我们对HD的高血压和ESKD患者进行了简单随机抽样横断面研究。结局为MUCH，如果进行24小时动态血压监测的参与者符合以下至少一项标准则确诊：（1）日间平均动态血压≥135 mmHg（收缩压）和/或≥85 mmHg（舒张压）；（2）夜间平均动态血压≥120 mmHg（收缩压）和/或≥70 mmHg（舒张压）；或（3）24小时平均动态血压≥130 mmHg（收缩压）和/或≥80 mmHg（舒张压）。数据采用描述性统计呈现。我们使用逻辑回归探索MUCH的危险因素，结果以比值比（OR）和95%置信区间（95%CI）报告。
纳入分析的104名参与者（中位年龄54.5岁，48.1%为女性）中，85人报告患有MUCH（患病率81.7%，95%CI 73.2 - 88.0%）。98.1%的参与者存在血压非勺型状态，非勺型在血压正常组占主导（患病率57.9%，95%CI 36.3 - 76.9%），反勺型在MUCH组占主导（患病率65.9%，95%CI 55.3 - 75.1%）。我们还确定了一些与MUCH风险较高相关的因素，即当前吸烟者（调整后OR = 3.49，95%CI 1.07至11.40）、HD治疗时间>48个月（调整后OR = 5.69，95%CI 1.48至21.81）、服用>3种抗高血压药物（调整后OR = 3.64，95%CI 1.11至11.92）以及需要α2肾上腺素能受体激动剂控制血压（调整后OR = 6.31，95%CI 1.12至35.62）。
在未进行动态血压监测且HD治疗中位时长为6年的ESKD患者中，MUCH和血压非勺型状态（非勺型和反勺型）的患病率非常高。为避免额外费用和不便，在进行诊室外血压监测以确诊之前，应首先筛查MUCH的危险因素。
